Extract from “Things That Matter”, by David Galler

Our mystery man was still on a ventilator, I hoped asleep as a result of the sedation we were giving him rather than unconscious due to a massive head injury. What I did know was that he was far too unstable for us to move him to be scanned in order to find out one way or the other. As it was, we were still only partway through our guideline for the assessment and management of severe trauma and still stuck at C!

Just keeping him alive had been our focus. He had multiple lines in now—big intravenous catheters in his right and left internal jugular veins for fluids, drugs and dialysis; an arterial line in the radial artery of his wrist; the large bore sheath in the right femoral artery through which Rowshan had so skilfully directed his catheters; a nasogastric tube to drain his stomach; his breathing tube of course attached to a $65,000 ventilator; and a urinary catheter, its drainage bag sadly empty of urine.

Although some of his bloods tests were better, because his kidneys had failed his blood desperately needed cleaning up. Gingerly, we got him onto dialysis with small boluses of adrenaline to keep his blood pressure up.

It had been a weird evening and I was sure something unusual and mysterious was afoot. I was exhausted but energised and strangely elated too! I walked around the ICU, checked on the other patients and then took a stroll outside. It was a beautiful night. In days past, I would have jumped the fence and gone for a swim in the hospital pool, but that was now long gone. I was hungry but all that was available was crap from an array of vending machines better trained to take your money than give you sustenance. A comfortable chair and my feet up on a verandah rail looking out across the night sky would have done but there was nowhere for that. Sitting in an office looking out the window wasn’t even possible because there were no offices with windows available to me. How weird, I thought, this place is supposed to make people better but it is so awful on so many counts.

There was one saving grace though: hospitals at night, stranger places than they are during the day, are ripe for the imagination to flourish. Like the southern motorway at the same dead time of night, they too have one long, empty corridor after another. The only signs of life are an occasional cleaner in a cowboy hat riding a big floor polisher, our equivalent of a growling roadworking machine lit up like a Christmas tree. Like the odd car, an occasional house surgeon will run a red between well-lit pods that could be gas stations but instead are the nursing stations on the wards. I want to breathalyse them all.

‘Life can only be understood backwards, but it must be lived forwards,’ said the great Danish philosopher Søren Kierkegaard. Ghosts and memories flood back to you in those dark hours before the dawn. Did Mama, the thirteen-year-old girl from Aitutaki, really need to die? Couldn’t we have done more? Dr Ken Mayo, his photo on the wall at the entrance to the radiology department, dead at fifty. His weathered face above his Viyella shirt and neatly knotted tie etched in my brain forever. I never want to end like that, all alone, dropping dead at work. I used to worry that one day I too would be remembered by a photo on a wall in the ICU but as time has passed so too has my anxiety about ending that way, certainly at that age.

I carried on past the entrance to the closed cafeteria and remembered the time I organised a concert by Tim Finn, who played to a crowd of kids and adults, all with burn injuries. The venue was grungy, the ceiling suitably low and pockmarked, much like the one at Ronnie Scott’s club in Soho. It was 25 June, Tim’s birthday and, at the end, all the patients and staff returned the favour and sang him a rousing version of ‘Happy Birthday’. He said it was the best present he’d ever had, and both he and I almost cried.

Down towards the coronary care unit I drifted. This place was a good run from the ICU on the first floor of the Galbraith block, opposite the Middlemore railway station. I’ve lost count of the number of long sprints I’ve done from one end of the hospital to the other to rescue patients from their hearts stopping prematurely, at the same time always anxious they might restart long after damage to the brain is certain. Arriving there, gasping, I would wonder whether I was next in line for a coronary. Catching my breath, I would follow the ACLS guidelines to shock and thump that dumb organ back into sinus rhythm.

At the end of each case, no matter the result, we always had an informal debrief over a cup of tea and a gingernut—biscuits that were always present in the jar at the nurses’ station. Looking back, these were special times: our performance was reviewed, new relationships were formed, and old ones reaffirmed.

As I wandered, I remembered the day in the early 1990s when—after a long and unsuccessful attempt to resuscitate a youngish man—we found the cookie jar empty and the tea no longer available. There was no debrief that day and we all trudged disconsolate back to our home wards. Soon after, the crackers, cheese and jam disappeared from the theatre tearoom, and with that stopped the unspoken, easy and relaxed conviviality that resulted from those of us attracted to it.

A face seen is a problem solved but there seemed little time or place for that kind of simple interaction between members of the specialist staff so soon after the mother of all budgets. More from less was the philosophy of the day. The buildings became meaner, the spaces smaller, access to the outdoors and natural light were not valued then nor are they much now. These are not environments conducive to learning, building and sustaining working relationships. They are places that I do my best to avoid and, when at all possible, leave.

Not long after that calamity, the hospital swimming pool— the closest world away from the turmoil and drama of the ICU and the wards you could ever imagine—was closed. Within a week it was covered with concrete. They certainly can be efficient when they want to!

Eventually, I went back to the ICU; it was close to 4 a.m. There I met Sandy and some of her family. She had become anxious when her husband of thirty years had not returned home from his bike ride so began looking for him, eventually phoning Middlemore. She was distraught when they told her that someone fitting his description was a patient in our hospital. Not knowing whether this was her husband, she told me things about him that I recognised. She then burst into tears when I gave her the medallion he had been wearing around his neck. A short while later, we went in to see him and then returned to the privacy of another room to talk.

Over the next little while I learned more about this man who was refusing to die. He was a family man with four children, and he ran a small successful business. When he was young he was a member of the Parachute Regiment of the British Army and had been a fitness fanatic ever since. Yesterday, he had been out training in preparation for a triathlon later in the year. Sandy described him as a dynamo, determined, committed and when he needed to be, totally focused on the task ahead. As she was speaking I could feel myself nodding in agreement as though I knew him almost as well as her.

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